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L------------------------- ---------------- <br /> ------------- -------------------------------- ..... AWLICATION FOR SANITATION PERMIt Permit No. .... <br /> ��J/. <br /> -------------------------.. ........... (Complete in Duplicate) <br /> a <br /> This Permit Expires I Year From Date Issued Date Issued .-_... t <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County rOrdinance No. 549. <br /> JOB ADDRESS AND CATION4?S- frtses9jC/__.[--� r-- �s. ilri- ? ? _!--/1...-_.. u -LCir(.E.... _. <br /> Owner's Name._.._..`, - - ---------------...-------.-------- Phone...----------------..._....._. <br /> Address-- ?� -V.k �S. --- -` _.... __ ......-.. <br /> Ree <br /> Contractor's Name............. ------------------------------- ----------------------------------------- Phone.----------•......---------•. <br /> Installation will serve: Residence Apartment House ❑ Commercial 0 Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ..(----- Number of bedrooms ....I--- Number of both...-- L t size„�, ��...P................................_ <br /> Water Supply: Public system ❑ Community system ❑ Private Cl ;C9NUto a' <br /> r I,,bz,��ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel. Sandy Loam [t Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ <br /> Previous Application Made: (If yes,date........._.---_ I No4 New Construction: Yes ❑ No N FHA/VA: Yes ❑ No �. <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if p blit se)w� is available within 200 feet.) VV <br /> Septic Tank: Distance from nearest well--�]W..�. [Drstanc from foundationof aria.! flL¢_ � �ry I� <br /> No. of compartments-- .---_-.-._vv-.Size__.)(-_�-K.4:_.Liquid depth___��/�._...-Capadty_g.Q..p.......... A`\ <br /> Disposal Field: Distance from nearest well Distance from foundation--------------------Distance to nearest lot line--....... <br /> 0 Number of lines------ ;.._----------- <br /> ----- <br /> .--_-Length of each line._.__.-_.____________--.Width of trench................................ <br /> _ Type of filter material-------------------------Depth of filter material...............--.-__.Total length............................ <br /> _ Seepage Pi Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................ <br /> ❑ l� Number of pits-.............-._-_Lining material----------.------------Size: Diameter----------------------Depth................................. <br /> Cesspool: Distance from nearest well.................Distance from foundation-------- ----------Lining material_----___.__---_------------------ <br /> ` ❑ Size: Diameter------------------------------Depth--------------------------------------------Liquid Capacity------............------.gals. 0Privy: Distance from nearest well-- _ _ - - - ..................... <br /> _ ___--.__---_-___. __-- - --..- .------Distance from nearest building ....__......_ _. <br /> ❑ Distance to nearest lot line . -------- --------------------------------------_------- <br /> Rem ling and or repairing (describe _ _ .. ..e_...._.._. .'A <br /> ........... ......... ... <br /> I here " certify that I hhve prepared this application and that the work will be done in accordance with San Joaquin County <br /> ordinances, tafe laws, and rules <br /> and regulations of the San Joaquin Local Health District. <br /> (Signed)---------------...... ,� ----------------------------...-------------------------------..(Owner end/or Contractor <br /> ci <br /> By:--------- L 2C�t<L2� - - ---------------------------------------(Title)------------------ -- ----- ----- _ ----- ... <br /> (Plot plan, showing size of lot, location of system in re No o wells, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY------------------------------------------------------------------_...---------------------- DATE------...............--......... - ................ <br /> REVIEWEDBY.----------------------------_----------------------------------------_... ------------------------------------ DATE---- <br /> BUILDING PERMIT ISSUED.......................................................- DATE--........... -- - - <br /> Alterations and/or recommendations:--------------------------------------------------------------------------...............--.....-...................................... <br /> ...................- ---------•.. . ---------------- ......_.. ..... -__--------------------.........................................................................................--....... <br /> -------------------I-----....................-...................------------I------ ------- ------........- . ...................--......................•-........---------.............................. <br /> ...............----------------------------------......---------­-----------­---------------- ------------------------ - ........................................--....................-----.............. <br /> ....................... . ---- -- r` <br /> FINAL INSPECTION BY: 4 -- ?"-------- Date.... .....ff.......f � .�^....•. <br /> " SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 124 Sycamore Stmt 205 Weft 9th street <br /> Stockton,California Lodi,California Manteca,California Tracy,California <br /> E6 9 REVISED 8-59 2M 6.61 ATLAS <br />